Background: Primary immune thrombocytopenia is not a rare event during pregnancy, and it must be carefully managed to avoid hemorrhagic complications for the mother. After failure of first-line treatments, the teratogenicity and toxicity of other therapeutic agents limit the available options and treatment.
Cases: We describe the cases of two pregnant patients with corticosteroid-refractory immune thrombocytopenia who were successfully treated by romiplostim, a thrombopoietin receptor agonist, without any fetal or maternal complications.
Conclusion: Romiplostim may represent an important alternative treatment choice during pregnancy for immune thrombocytopenia cases refractory to first-line therapy, especially because of its speed of action and high efficacy. Nevertheless, further data are required to provide definitive evidence of its safety for newborns.